Tuition Remission Form for an Undergraduate Degree At one of The Claremont Colleges Employee Full Name: Deadline: This form must be completed and submitted before the start of each semester/session for which the benefit is requested Failure to so may result in ineligibility for the benefit Summer sessions count towards the new fiscal year benefit The student is a(n): Employee Dependent Name: _ Relationship: Institution of Enrollment: _ Semester: Year: 20 _ # of Courses: Is the student receiving any financial assistance, such as a scholarship, fellowship, or other financial aid? (Note: some forms of aid may reduce your Tuition Remission benefit eligibility amount.) No financial aid Yes: Total Amount $ _ I hereby apply for the tuition remission benefit for the above student for the semester and units/courses indicated I understand and accept that if the student is not in “good academic standing” as defined by the institution of enrollment AND/OR withdraws from the course(s) for any reason or otherwise does not successfully complete the course(s) I will be responsible for the payment of any and all tuition costs owed to the institution of enrollment I further understand that this benefit is for tuition costs only Employee Signature: _ Date: / / _ Confirmation of Eligibility - HR The employee is eligible for the Pitzer College tuition remission benefit described above as follows: 100% of tuition (Employee) 50% of tuition, up to 50% of Pitzer’s current tuition cost (Dependent) Human Resources Officer: _ Date: / / _ Verification of Successful Completion and Good Academic Standing I verify that the above named student: is is not: in “good standing” as defined by the institution of enrollment has “successfully completed” * _ course(s) for the semester of 20 _ * A passing grade must be received Registrar’s Officer: _ Date: / / _ Payment – HR Total Tuition Benefit Amount $ Payment Date: / / _ Processed by: Pitzer Account: CC67800 FD100, FN230, S0219 (Dependent) S0725 (Employee), Ledger 5800 HMC: CC50030 FD170 FN150 R0054 Ledger 2710 PG50957 POM: CC06031 FD100 FN160 Ledger 2510 Final Copies: Employee / Human Resources / Student Accounts SCR: CC35700 FD1700 FN200 R0018 Ledger 1140 PG30202 Pitzer Tuition Remission paid by Office of Student Accounts Provided form to Student Accounts on: Date: HR Initials: TuitionRemissionForm_Undergrad_06/12/19.docx Pitzer College T U I T I O N R EM I S SI O N P O L I C Y Eligibility: All benefit-eligible employees in regular positions at Pitzer College who qualify under the following guidelines, will be covered under this Tuition Reimbursement Plan Staff in temporary positions, and faculty in non-tenure track appointments are not eligible Full-time employment for staff is defined as working 12 months, 40 hours per week Part-time is defined as any regular employment, less than 12 months but at least 20 hours per week, and excludes temporary or on-call status Full-Time Employee Coverage: After l2 months of full-time continuous employment at Pitzer College, employees shall be eligible to receive: (a) full tuition support for up to four courses per academic year (summer inclusive), when enrolled as degree candidates in good standing at Pitzer College; or (b) up to two courses per academic year (summer inclusive), when enrolled as degree candidates at any one of The Claremont Colleges Dependent Children of Full-Time Employees: After l2 months of full-time continuous employment at Pitzer College, the dependent children of employees shall be eligible to receive half-tuition support, not to exceed one-half the cost of Pitzer tuition, when enrolled as degree candidates in good academic standing at any one of the undergraduate Claremont Colleges Class Attendance for Full-Time Employees: Full-time employees may be granted up to three hours leave per week at the discretion of the employee's supervisor to attend classes conducted during the traditional work hours of the College Part-Time Employee Coverage: After four years of continuous employment at Pitzer College, regular part-time staff working at least 20 hours per week are eligible to receive full tuition support for up to four courses per academic year (summer inclusive) at Pitzer College when enrolled as degree candidates in good standing Dependent Children of Part-Time Employees: After four years of continuous employment at Pitzer College, the dependent children of part-time employees shall be eligible to receive half-tuition support, when enrolled as a degree candidates in good academic standing at Pitzer College Payments: Tuition reimbursement will be made to the student's account only upon successful completion of coursework It is the responsibility of the student and/or employee to submit an application form to the Director of Human Resources at the beginning of each semester Forms will be forwarded to the College Registrar for verification of course completion at the end of each semester IMPORTANT NOTICE Tuition is defined as such and may not be applied to any other expenses, such as room & board, laboratory fees, doctoral study fees, continuing education fees, community fees, off campus fees, etc Auditing: With instructor approval, any Pitzer College employee may audit courses at any of The Claremont Colleges Death Benefit: Half-tuition will be paid by Pitzer College for dependent children when enrolled at any one of the undergraduate Claremont Colleges as degree candidates in good academic standing up to five years from the date of death of any employee who has served the College for five or more years Where death occurs between two and five years, the College shall adjudicate the half tuition privilege Unpaid Leave Status: Employees on unpaid leave status are not normally eligible to receive tuition reimbursement benefits for themselves during the period of their leave